McNicholas M M, Raptopoulos V D, Schwartz R K, Sheiman R G, Zormpala A, Prassopoulos P K, Ernst R D, Pearlman J D
Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
AJR Am J Roentgenol. 1998 May;170(5):1261-7. doi: 10.2214/ajr.170.5.9574598.
The purpose of our study was threefold: to evaluate the ability of excretory phase CT urography to opacify the urinary collecting system by comparing opacification seen on CT with the opacification seen on a series of unmatched IV urography examinations; to determine the optimal CT urography technique for ureteral filling by comparing studies of patients who were imaged supine, prone, and with abdominal compression; and to assess the possible value that reformatted planar images might add to axial excretory phase images.
Seventy patients with hematuria were imaged in one of four ways. Twenty-five patients underwent contrast-enhanced excretory phase helical CT of the kidneys, ureters, and bladder. All patients were imaged in a supine position. Ten other patients underwent a similar CT protocol in which we used abdominal compression. Ten further patients underwent excretory phase CT while in a prone position. A final 25 patients underwent IV urography. Each patient's collecting system was arbitrarily divided into 10 parts (both right and left sides of calices; pelvis; upper, mid, and lower ureters) for scoring of images on a five-point scale for opacification by contrast material. Opacification scores for the four groups of patients were then compared. For patients who underwent CT, reformatted images of the collecting systems were generated and evaluated for their potential to add value to the conventional axial images.
We found no significant difference in the ability of CT urography and IV urography to yield opacification of the calices, pelvis, and upper or mid ureters. Opacification of the distal ureter was less well seen on supine CT urography than on IV urography. Prone and compression CT urography resulted in better opacification of the collecting system than the supine noncompression technique. Opacification of the distal ureter was best seen with compression CT and was as good as that seen with IV urography. Reformatted CT urography was judged to be of probable or definite additional value to the axial images in 44% of cases. In each case, we saw a pathologic finding whose relationship to the kidney and collecting system was not as easy to appreciate on the axial CT scans.
CT urography with abdominal compression results in reliable opacification of the collecting system that is comparable with opacification seen on IV urography. In patients with abnormalities, reformatted images were a useful adjunct to axial images. CT urography has potential as an imaging tool for the urothelium.
我们的研究目的有三个方面：通过比较CT上的造影剂充盈情况与一系列不匹配的静脉肾盂造影检查所见的造影剂充盈情况，评估排泄期CT尿路造影使泌尿系统集合系统显影的能力；通过比较仰卧位、俯卧位及腹部加压患者的研究结果，确定输尿管充盈的最佳CT尿路造影技术；评估重组平面图像对轴位排泄期图像可能增加的价值。
70例血尿患者采用四种方式之一进行成像。25例患者接受了肾脏、输尿管和膀胱的对比增强排泄期螺旋CT检查。所有患者均取仰卧位成像。另外10例患者接受了类似的CT检查方案，其中我们采用了腹部加压。另有10例患者在俯卧位时接受排泄期CT检查。最后25例患者接受静脉肾盂造影检查。将每位患者的集合系统任意分为10个部分（肾盏的左右两侧；肾盂；输尿管上、中、下段），根据造影剂充盈情况在五点量表上对图像进行评分。然后比较四组患者的造影剂充盈评分。对于接受CT检查的患者，生成集合系统的重组图像，并评估其对传统轴位图像增加价值的潜力。
我们发现CT尿路造影和静脉肾盂造影在使肾盏、肾盂及输尿管上段或中段显影方面的能力无显著差异。仰卧位CT尿路造影对输尿管下段的显影不如静脉肾盂造影。俯卧位和加压CT尿路造影比仰卧位非加压技术能使集合系统更好地显影。加压CT对输尿管下段的显影最佳，与静脉肾盂造影所见相当。在44%的病例中，重组CT尿路造影被认为对轴位图像可能有或肯定有额外价值。在每个病例中，我们都发现了一个病理发现，其与肾脏和集合系统的关系在轴位CT扫描上不那么容易辨认。
腹部加压的CT尿路造影能使集合系统可靠地显影，与静脉肾盂造影所见的显影情况相当。在有异常的患者中，重组图像是轴位图像的有用辅助手段。CT尿路造影有潜力作为尿路上皮的成像工具。
